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New Drugs for Rheumatoid Arthritis: Is a Biologic Pill on the Way?

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The advent of a new class of drugs known as biologics has revolutionized the treatment of rheumatoid arthritis (RA). These drugs, which include Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, and Simponi, must be given via self-injection or intravenous infusion in the doctor’s office or hospital. They also can be expensive and are not always covered by insurance.

For those reasons and more, researchers are working to develop oral biologics -- biologics you could take as a pill.

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Young Adults Living With RA

Last winter, after spending a few afternoons shoveling snow, Heather Miceli, 27, woke up in the middle of the night and couldn’t get out of bed. “My joints had swelled up so much that I couldn’t move without crying,” she says. Two months later, the college professor at Johnson and Wales University in Providence, R.I., who had always been healthy, was diagnosed with rheumatoid arthritis (RA) -- a debilitating autoimmune disease that causes inflammation and swelling in the joints and surrounding tissues,...

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RA, an autoimmune disease affecting 2 million people, happens when the body engages in friendly fire against its own joints and tissues, causing inflammation, pain, and joint damage. Drugs called disease-modifying antirheumatic drugs (DMARDs) and biologics stop the progression of RA, reducing inflammation and halting joint damage.

“It used to be that our waiting rooms were full of patients with deformities in wheelchairs and some whose hands were so deformed that they didn’t even look like hands, and we don’t see that anymore mainly because of the biologics,” says Dalit Ashany, MD, a rheumatologist  at the Hospital for Special Surgery in New York City.

However, she says, many people with RA resist getting injections and IVs -- the only way that biologics are available. It would be much simpler to be able to take biologics in pill form than to have to self-inject the drugs or go to the hospital for infusion. 

“Pills are also much cheaper than injections and infusions,” she says. “Insurance companies make us go through hoops to prove that RA patients need the drugs, and some can’t afford them without coverage.”

Biologics are made using large protein molecules that are taken from living things. This involves a more complex and expensive manufacturing process.  Generic versions would be cheaper, but these drugs are so new that they are also protected under patent. Furthermore, the FDA does not have a process in place for approving generic biologics.

Oral Biologics: In the Pipeline?

Eric Matteson, MD, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minn., is not 100% convinced that we will see oral biologics in the near future.

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